Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy

Alan Kadish, Alan Dyer, James P. Daubert, Rebecca Quigg, N. A Mark Estes, Kelley P. Anderson, Hugh Calkins, David Hoch, Jeffrey Goldberger, Alaa Shalaby, William E. Sanders, Andi Schaechter, Joseph H. Levine

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown. METHODS: We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or non-sustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD. RESULTS: Patients were followed for a mean (±SD) of 29.0±14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percentconfidence interval, 0.06 to 0.71; P=0.006). CONCLUSIONS: In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.

Original languageEnglish (US)
Pages (from-to)2151-2158
Number of pages8
JournalNew England Journal of Medicine
Volume350
Issue number21
DOIs
StatePublished - May 20 2004

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Defibrillators
Dilated Cardiomyopathy
Implantable Defibrillators
Group Psychotherapy
Sudden Death
Angiotensin-Converting Enzyme Inhibitors
Stroke Volume
Cardiac Arrhythmias
Ventricular Premature Complexes
Mortality
Sudden Cardiac Death
Risk Reduction Behavior
Ventricular Tachycardia
Cause of Death
Confidence Intervals
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

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Kadish, A., Dyer, A., Daubert, J. P., Quigg, R., Estes, N. A. M., Anderson, K. P., ... Levine, J. H. (2004). Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy. New England Journal of Medicine, 350(21), 2151-2158. https://doi.org/10.1056/NEJMoa033088

Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy. / Kadish, Alan; Dyer, Alan; Daubert, James P.; Quigg, Rebecca; Estes, N. A Mark; Anderson, Kelley P.; Calkins, Hugh; Hoch, David; Goldberger, Jeffrey; Shalaby, Alaa; Sanders, William E.; Schaechter, Andi; Levine, Joseph H.

In: New England Journal of Medicine, Vol. 350, No. 21, 20.05.2004, p. 2151-2158.

Research output: Contribution to journalArticle

Kadish, A, Dyer, A, Daubert, JP, Quigg, R, Estes, NAM, Anderson, KP, Calkins, H, Hoch, D, Goldberger, J, Shalaby, A, Sanders, WE, Schaechter, A & Levine, JH 2004, 'Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy', New England Journal of Medicine, vol. 350, no. 21, pp. 2151-2158. https://doi.org/10.1056/NEJMoa033088
Kadish, Alan ; Dyer, Alan ; Daubert, James P. ; Quigg, Rebecca ; Estes, N. A Mark ; Anderson, Kelley P. ; Calkins, Hugh ; Hoch, David ; Goldberger, Jeffrey ; Shalaby, Alaa ; Sanders, William E. ; Schaechter, Andi ; Levine, Joseph H. / Prophylactic Defibrillator Implantation in Patients with Nonischemic Dilated Cardiomyopathy. In: New England Journal of Medicine. 2004 ; Vol. 350, No. 21. pp. 2151-2158.
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AU - Kadish, Alan

AU - Dyer, Alan

AU - Daubert, James P.

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AU - Estes, N. A Mark

AU - Anderson, Kelley P.

AU - Calkins, Hugh

AU - Hoch, David

AU - Goldberger, Jeffrey

AU - Shalaby, Alaa

AU - Sanders, William E.

AU - Schaechter, Andi

AU - Levine, Joseph H.

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N2 - BACKGROUND: Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown. METHODS: We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or non-sustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD. RESULTS: Patients were followed for a mean (±SD) of 29.0±14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percentconfidence interval, 0.06 to 0.71; P=0.006). CONCLUSIONS: In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.

AB - BACKGROUND: Patients with nonischemic dilated cardiomyopathy are at substantial risk for sudden death from cardiac causes. However, the value of prophylactic implantation of an implantable cardioverter-defibrillator (ICD) to prevent sudden death in such patients is unknown. METHODS: We enrolled 458 patients with nonischemic dilated cardiomyopathy, a left ventricular ejection fraction of less than 36 percent, and premature ventricular complexes or non-sustained ventricular tachycardia. A total of 229 patients were randomly assigned to receive standard medical therapy, and 229 to receive standard medical therapy plus a single-chamber ICD. RESULTS: Patients were followed for a mean (±SD) of 29.0±14.4 months. The mean left ventricular ejection fraction was 21 percent. The vast majority of patients were treated with angiotensin-converting-enzyme (ACE) inhibitors (86 percent) and beta-blockers (85 percent). There were 68 deaths: 28 in the ICD group, as compared with 40 in the standard-therapy group (hazard ratio, 0.65; 95 percent confidence interval, 0.40 to 1.06; P=0.08). The mortality rate at two years was 14.1 percent in the standard-therapy group (annual mortality rate, 7 percent) and 7.9 percent in the ICD group. There were 17 sudden deaths from arrhythmia: 3 in the ICD group, as compared with 14 in the standard-therapy group (hazard ratio, 0.20; 95 percentconfidence interval, 0.06 to 0.71; P=0.006). CONCLUSIONS: In patients with severe, nonischemic dilated cardiomyopathy who were treated with ACE inhibitors and beta-blockers, the implantation of a cardioverter-defibrillator significantly reduced the risk of sudden death from arrhythmia and was associated with a nonsignificant reduction in the risk of death from any cause.

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